The E words, Eradication and Elimination, are firmly back on the table after at least 2 decades in which they could not be mentioned in polite malaria company. The last two years have seen remarkable progress in translating these concepts into clear strategies and substantial action.
The broad multi-decade strategy for our journey to a world free of malaria is expressed in three parts:
- Aggressive control in the heartland, to achieve very low transmission and mortality in those tropical countries currently experiencing the highest burden of disease and death.
- Progressive elimination from the endemic margins to shrink the malaria map.
Research to bring forward a vaccine and better drugs, diagnostics, insecticides and other tools.
The first and third of these strategic elements have been receiving considerable effort since the creation of the Global Fund in 2002, and the rapid rise in commitments by the Gates Foundation to malaria research and development at about the same time. The second element, namely continuing the historical process of progressive spatial malaria elimination from the endemic margins inwards, has recently received needed attention through the work of the Global Health Group (GHG) at the University of California, San Francisco, and the Malaria Elimination Group (MEG) which the GHG convenes and supports. This has been made possible by funding from the Bill and Melinda Gates Foundation and ExxonMobil. Progress to date in the elimination space can be characterized under the headings global, regional, and country.
Global progress has been stimulated by the work of MEG, a group of 45 individuals from 18 countries. MEG will meet for the fourth time in Hainan, China, during December, 2009. MEG has produced two landmark publications:
- Shrinking the Malaria Map: A Prospectus on Malaria Elimination
- Shrinking the Malaria Map: A Guide on Malaria Elimination for Policy Makers
These publications (which can be found at MalariaEliminationGroup.Org) compile both existing and new evidence on the technical, financial, and operational feasibility of malaria elimination. They are widely used and consulted in the 39 countries that are either embarked on elimination today or are seriously contemplating sub-national or national elimination goals.
At the regional level, noteworthy progress includes the creation of the Elimination Eight (E8), under the chairmanship of Dr. Richard Kamwi, the Minister of Health of Namibia. The E8 brings together the four front line eliminating countries in southern Africa ((Botswana, Namibia, South Africa, and Swaziland) and their four northern neighbors (Angola, Mozambique, Zambia, and Zimbabwe). The E8 held its inaugural meeting in Windhoek in March, 2009, and is embarking on a program of effective technical and operational collaboration, with a particular focus on cross-border efforts.
The second major regional initiative is the Asia Pacific Malaria Elimination Network (APMEN). Announced by Australian Prime Minister Kevin Rudd at the UN General Assembly in September, 2008, APMEN had it inaugural meeting in Brisbane in February 2009. It is collaboration among the 10 elimination countries in the Asia Pacific region: Bhutan, China, DPRK, Indonesia, Malaysia, Philippines, Solomon Islands, ROK, Sri Lanka, and Vanuatu. Australia has played a critical role in supporting this initiative. Collaborative operational research and the sharing of experience will soon get underway, with a particular focus on P.vivax. The second meeting of APMEN will be held in Kandy, Sri Lanka, in February, 2010.
At the country level, there is significant progress taking place across all of the 39 elimination countries. These countries have adopted their elimination goals on the basis of their own assessments of feasibility. In some cases, they are part of regional multi-country collaborations, while in others these are individual country efforts. In all cases, cross-border collaboration with neighbors that are less advanced in malaria control is a critical element of success.
In summary, the journey to eradication, which will surely last 4 decades or more, has begun. Much more remains to be done. Many challenges lie ahead. Science will continue to bring us new tools and approaches which, if boldly and vigorously applied, will ensure that we continue to maintain today’s strong momentum and to drive down malaria deaths and illness in all malarious countries, while simultaneously continuing to Shrink the Malaria Map.
Professor Sir Richard Feachem
Director, Global Health Group